Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP30000744 | WA |
NPI | 1003804055 |
---|---|
Provider Name | Ms. Marty R. Babcock |
First Address | Seattle, WA 98144-2712 |
Second Address | Seattle, WA 98144-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8642001 | (05) | WA |
S45661 | (02) | WA |